Understanding IBS Symptoms
The symptoms of irritable bowel syndrome (IBS) can vary quite widely from person to person. You might have to cope with mild diarrhea and bloating, whereas I might have severe constipation and stomach cramps.
One person might be able to control their IBS symptoms fairly easily with diet or medication, whereas another might find their whole life is affected by their illness and they struggle even to hold down a job.
There are no hard and fast categories for the severity of IBS, but doctors may use the terms mild, moderate or severe to assess how badly you are affected. A defining feature of IBS is that these symptoms will usually vary over time, so a patient may have weeks or months where they are suffering badly but then have periods of time when they feel much better.
Here are nine symptoms that you may experience if you have irritable bowel syndrome.
Let’s start by looking at pain because many people don’t realize that pain is a significant feature of IBS. In reality, a massive three-quarters of sufferers say they have to cope with IBS-related pain that they either feel all the time or very often.
For many people the pain can be the most difficult symptom to bear, particularly as IBS is a chronic condition that can affect you for months or years, gradually wearing you down over time.
Stomach cramps and pains are such a big part of IBS that you cannot be diagnosed with IBS if you have no pain at all (according to the Rome Criteria, the list of symptoms that doctors use to diagnose IBS). These pains may feel like a mildly uncomfortable feeling around your belly, a sharper, stabbing sensation or a full, heavy stomachache. The pain will often reduce after a bowel movement but increase after a meal, due to the amount of pressure within the gut.
Most healthy people will experience a certain level of pain when they have constipation or diarrhea, but in IBS this problem is exacerbated because the brain is even more sensitive to pain signals from the intestinal nerves than normal. This is known as “hypersensitivity” and means that where a healthy person might feel little or no pain in a certain situation – a few days of constipation, for example – an IBS person would feel much more pain.
The “brain-gut axis” malfunctioning causes this sensitivity – the communication between brain and gut has gone very wrong. So when the body tells the brain of an IBS sufferer that it’s in pain, the brain interprets the pain as being far more severe than it actually is. In experiments that used brain imaging, it’s been proven that IBS brains actually react differently to pain than the brains of healthy people.
The pain of IBS can be difficult to deal with because it often doesn’t respond to basic painkillers like Tylenol or ibuprofen and the stronger painkillers like codeine can cause gut problems themselves.
Usually, the best way to tackle the pain is to attack the diarrhea or constipation that’s causing it. Once the normal rhythm of the bowel is regained, the pain should disappear.
Diarrhea experienced by IBS sufferers is usually characterized by two things – the number of bowel movements (BMs) passed each day and how quickly you need to get to the bathroom. It’s usually defined as more than three BMs per day. In women, diarrhea can be particularly bad just before or just after their get their period.
Patients with mild or moderate IBS-D might have three or four bowel movements in a day, whereas those with severe symptoms can have many more, to the point where it can be difficult to leave the house and live a normal life.
Diarrhea is often at its worst in the morning and can be particularly bad just after the first meal or hot drink of the day. This is because of the gastrocolic reflex, a fancy term which just means that the bowel is most active after a meal. Stools will often be loose and watery, although not always.
Urgency can be a very distressing part of this illness. In a healthy person, the body sends a message that a bathroom is needed but this urge can be ignored if necessary, and the BM delayed.
For an IBS sufferer, the message can often be “Get to a toilet NOW!” If there’s no toilet nearby, then incontinence can be the result, a horrible part of this illness that only occurs, thankfully, in a small number of patients with the most severe version of the disorder.
If you don’t visit the restroom three or more times per week, you might be constipated. This symptom often brings hard, small stools that are difficult to pass; this is because the waste matter has been inside the body too long and the colon has absorbed too much water. Bowel movements may look like pellets or be larger than usual.
When constipation continues for several days or more, it can become more and more painful as the pressure within the body builds. If you’re having to strain on the toilet, this can sometimes lead to hemorrhoids, swollen veins that are a bit like varicose veins in the anus or rectum. Hemorrhoids are not a specific symptom of IBS, but they are fairly common in IBS sufferers because of all the gut troubles we suffer from. (Some diarrhea sufferers get them too.)
Although patients with constipation-predominant IBS generally avoid the urgency and incontinence problems of IBS-D and don’t need to stay close to a restroom, this “advantage” is often offset by the fact that they may rarely feel completely comfortable and often find that the pain increases as more and more days go by without a BM.
It’s worth mentioning that one person’s idea of constipation may be different to another’s. Obviously not going to the bathroom for many days means you are constipated, but some people refer to constipation when they mean a stool was hard to pass, others when they mean that they’re not getting any urge to go to the bathroom at all. Generally, though doctors use the “three times or less” per week rule as their definition.